Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 25MA08883500 | NJ |
NPI | 1104064971 |
---|---|
Provider Name | Dr. Victoriya Staab |
First Address | Neptune, NJ 07753-4488 |
Second Address | Neptune, NJ 07753-4488 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2009 |
Last Update Date | 02/08/2021 |